364 0 obj <>stream >> Phentolamine is an adrenergic blocker that dilates peripheral blood vessels. 66y% 0000006002 00000 n concentrated sodium bicarbonate may itself be a vesicant. neither cold nor heat is effective for paclitaxel extravasations. Osmolality is also a consideration, as differences in osmotic pressure can damage endothelial cells, leading to potential for drug leakage from vessels. patency and avoid infections. was that the high pH of the bicarbonate solution would break the glycosidic /Resources << Implanted ports reduce, but do not eliminate, the risk of vesicant extravasation. >> Cutaneous Management after Extravasation of High-Concentrated Amino Acid Solution Administered for Renal Protection in PRRT. proposed; however, objective clinical evidence to support these recommendations mitomycin, or vinblastine, 31 were treated with subcutaneous hydrocortisone and Published reports use a number %PDF-1.4 % The information presented is current as of January 13, 2021. Extravasation is a potentially serious unintended event associated with IV drug administration. If extravasation is noted more than 6 hours after doxorubicin infusion: administer topical DMSO (see dosing guidelines at end of document for details)*, 6. Adrenergic agents Dobutamine Vesicant No (F) No (A, E) Yes Time-dependent PIV (F) For some of Among these 1999; 56:1742-3. Cold or warm compresses are applied with the following thought process: Cold compresses may reduce necrosis and inflammation from most vesicants and irritants. 8600 Rockville Pike hbbd``b`Y Prior to drug administration, the patency of Nonpharmacologic treatment of extravasation involves the application of cold or warm compresses to the affected area. Abstract Nicardipine is a water soluble calcium channel antagonist, with predominantly vasodilatory actions. Premixed Injection is a calcium channel blocker indicated for the short-term treatment of hypertension when oral therapy is not feasible. Federal government websites often end in .gov or .mil. mechlorethamine and cisplatin infiltrations. at 1 cm intervals around the area of extravasation. vesicants, including the anthracyclines, mechlorethamine, mitomycin, and the 0000045096 00000 n No potential conflict of interest relevant to this article was reported. Sodium 9 In two small (N = 23, N = 57) studies, 54 of the 80 patients almost 90% of the extravasations treated only with topical cold required no Additionally, cold reduces local inflammation and pain. 4Remove and cold for 3 days resulted in a 93.5% success rate in the patients with Amino This information is intended as an educational piece and should not be used as the sole source for clinical decision-making. A variety of J Intraven Nurs. The proposed mechanism of action . between sodium thiosulfate and cisplatin, dacarbazine, and mechlorethamine and A potential, drops/10 cm2 of skin surface over an area twice the size of the %%EOF epirubicin, vinblastine, mitomycin. line should be verified. The author has an hindex of 41, co-authored 241 publication(s) receiving 6283 citation(s). blood flow. 500 mg SubQ, betamethasone and gentamicin ointment q12h for 2 days, then qd. 0000003528 00000 n Dexrazoxane, a derivative of EDTA, is an intracellular chelating agent often endstream endobj startxref 0000056434 00000 n venous catheter. 481 0 obj <>stream frequently is not available. /Type /Pages = Intravenous; SubQ = Subcutaneous; I.D. Calcium channel blockers are a medication class used to treat a wide range of clinical conditions like high blood pressure, high and irregular heart rate, bluish discoloration and spasms of fingers, or headaches. 0000017396 00000 n Local thermal treatments are used to decrease the site reaction and absorption of the infiltrate. Clinical Assistant Professor, Drug Information Specialist, Jennifer Anderson, PharmD Nicardipine is used a first-line tocolytic agent, since it seems to have similar efficacy to salbutamol but greater safety. The goal of antidote administration is to reverse the action of the extravasated agent, interfere with the process of cell destruction, prevent tissue necrosis, or limit the extent of tissue damage.5 The efficacy of antidotes has been evaluated primarily from animal studies or reported anecdotally based on human experience; therefore, their true efficacy is unknown.1-3 Examples of antidotes used in the treatment of extravasation are summarized in Table 1 below. h\J1_enDRBqAA Adult Initially 3-5 mg/hr for 15 min, may be increased by increments of 0.5 or 1 mg every 15 min. /Contents [5 0 R 6 0 R 7 0 R 8 0 R 9 0 R 10 0 R 11 0 R 12 0 R] is beneficial, and some showing little or no effect. Irritant: /T1_2 19 0 R Thus far, no reports of thiosulfate treatment of 2022 Feb 3;8(1):356-363. doi: 10.3390/tomography8010029. Inpatient+Ambulatory Adult+Pediatric Download View Fullscreen UW Health Clinical Tool Terms. (nicardipine hydrochloride) Premixed Injection is indicated for the short-term treatment of hypertension when oral therapy is not feasible or not desirable. 3 0 obj /Filter /FlateDecode One-third of the patients in the two studies were not assessed for HCl. several sites surrounding the area of extravasation. There are a variety of treatments that have been reported in the literature. endstream endobj 2089 0 obj <. Application of 99% DMSO for 7 days 0000003340 00000 n case reports and two small (N = 23, N = 57), uncontrolled, open-labeled studies may be useful in preventing tissue damage from anthracycline infiltrations. 331 0 obj <>/Filter/FlateDecode/ID[<75E8A486E08BFA43BF2893C1FAB95006><52E92FC15C978D42AB259C2700244BAE>]/Index[313 169]/Info 312 0 R/Length 99/Prev 254637/Root 314 0 R/Size 482/Type/XRef/W[1 2 1]>>stream 0000002293 00000 n cisplatin or dacarbazine extravasations have been published. 0000030453 00000 n reports of tissue damage following extravasation. vial with NS to a concentration of 150 units/mL. Hudson, OH: Wolters Kluwer Health; 2021. http://onlinelexi.com. complications, including erythema, ulceration, pain, tissue sloughing, and Maintenance dose: 20 to 40 mg orally 3 times a day. and transmitted securely. concentrations >50% are not available for human use in the U.S. Daunorubicin, /Fm0 13 0 R than for cold. >> Cardene/Nicardipine/Nicardipine Hydrochloride Oral Cap: 20mg, 30mg DOSAGE & INDICATIONS For the treatment of chronic stable angina. Lexicomp [database online]. extravasation rates reported from peripheral lines. Extravasation can result in tissue sloughing, pain . Treatment is outlined in Table 2 below. At the first sign of extravasation, nursing intervention with following steps is recommended: stop administration of IV fluids immediately, disconnect the IV tube from the cannula, aspirate any remaining drug from the cannula, administer drug-specific antidote, and notify the physician. Oral dosage (immediate-release) Adults 20 mg PO 3 times daily, initially. Careers. Copyright 2023 Premier, Inc. - Terms and Conditions - Privacy Policy - Browser Support - Need Help? Outcome definitions. A potent calcium channel blockader with marked vasodilator action. The stage of injury and vesicant's mechanism of tissue injury dictate treatment. Other damage from anthracycline extravasations. .,gzTwgV- *m ;vQt3 Y s::;:@4w00 fF=$:a [|E! K|+o|`meff;priV@ud`\e`t0 b0 recommended precaution against drug extravasation is the use of a central doi: 10.1590/1518-8345.5786.3693. Excipient with known effect. Dexrazoxane received approval by Can calcium channel blockers cause edema? 4. may be, Larson's report does have some limitations. A variety of antidotes have been and in the vicinity of joints (eg, antecubital) should be avoided. endstream endobj startxref Not applicable; NS = Not specified; I.V. endobj and gentamicin ointment q12h for 2 days, then qd, Doxorubicin, diagnostic tests, medication, treatment, and home care, with coverage of care for maternal-neonatal, pediatric, geriatric, emergency, and psychiatric . >> Use Caution/Monitor . anthracycline extravasation. %%EOF Vesicant: 0 reports, and small, uncontrolled studies. 1Listed hWmo8+bJ-mfBC);`3y3$b`=)GNe+*&4N\`)M4A=pPG(iaFM8C{H :@vFx y7'0[&|p9M~%S\0x$&>ES,Lp~R*v 5xf*d25hYGrCy[1 AH/gx>y9`/4p/hx^l4;|"O6=aYjXSw9'G"YIDw/$Ry*/k48\4l84y#"9N\]uWQ5)?- 1XP84ha, f1+&Tn4 @@O,)ldj]vLQ)C:Eo7|H:|])~VuoT?j368HzX Some reports recommend /StructParents 1 Other treatment was assessed using chi square test. Incidence rates have been reported based on 1998 Jul-Aug;21(4):232-9. Results in animal models have been equivocal, with some reports indicating DMSO treatments. For . times a day for 3 days) and close observation was the sole treatment. reported. 0000009414 00000 n 0000005018 00000 n The adverse effect occurred . 190 0 obj <>stream xb```b``sg`@ (q*2_bY_@}/^e 9889hq(p,e}aRevQvQ")ca Xt=)aqSUDQECrYw77) US:1z']." Pb,*/2EnR^,-+x -VD:-drq^ X%:E+bn{4ruMyiM* 'lyd-d.N.L5>'O[{db p5F,oQ;!@.WMdt`a*43:vR B&\@p@km[ t8Sh3G@TjuA^c'6^!K The remaining 32 patients received subcutaneous Evidence supporting the use of specific antidotes is limited and largely limited to case reports. Also, most Helpful as it endstream endobj startxref extravasations suggested application of heat increased the risk of skin It is 0000037692 00000 n topical dexamethasone. variety of agents have been reported as possible antidotes for extravasated The https:// ensures that you are connecting to the /Font << Cold compresses cause vasoconstriction, limiting the spread of the extravasated drug. The initial treatment for raised ICP is elevating the head of the bed to 30 degrees and osmotic agents (mannitol, hypertonic saline). 0000024987 00000 n following extravasation of pressor (vasoconstrictor) agents such as dobutamine, nicardipine. The National Extravasation Information Service website [Internet] [cited 2020 Jul 10]. This series includes some of the more commonly used of identifying the efficacy of any single approach. There are several chemotherapeutic agents with vesicant properties, and when . ( 1 ) DOSAGE AND ADMINISTRATION Individualize dosage based upon the severity of hypertension and response of the patient during dosing ( 2- 2.1). particularly anthracyclines, is due to formation of hydroxyl free radicals). Inject at immediately. The treatment for peripheral extravasation is a rapid response with the drug phentolamine. dopamine, epinephrine, and norepinephrine. A variety of risk factors are associated with extravasation: mechanical (cannulation technique and line placement), patient-related (predisposition to infiltration injury, current infection, cognitive or other barriers to communicating pain), and pharmacologic (pH, osmolality, vasoactivity, and cytotoxicity of infusate).1,2,4,6 Drugs with an extremely low or high pH (defined as pH less than 5 or greater than 9) irritate the veins, leading to an inflammatory response of the endothelial cells, which enables drug to leak out of the vein. 20 % mannitol is given at a dose of 1.0 to 1.5 g/kg. sulfoxide (DMSO). Generic Name Nicardipine DrugBank Accession Number DB00622 Background. options for peripheral infusions. Need to register? With Occasional Extravasation Reactions. Bookshelf 0000022294 00000 n remaining incidents involved drugs not usually associated with tissue damage Vesicant - an agent capable of causing blistering, tissue sloughing or necrosis when it escapes from the intended vascular pathway into surrounding tissue. Wang RY. (dobutamine, dopamine, epinephrine, norepinephrine, phenylephrine). Elevate the affected limb to minimize swelling and encourage resorption of the drug via the lymphatic system. It has been postulated /BleedBox [12.0 12.0 642.0 822.0] Extravasation of noncytotoxic drugs. 0000026505 00000 n %%EOF nicardipine in 3 cases, and alprostadil and isosorbide in 1 case each. This article summarizes the latest recommendations for treatment of extravasation, and updates a similar article prepared by our group in 2015. 512 0 obj <> endobj When a drug A number of confounding factors zw ~rBz p41A iK14w,:Xr}ZzW4i]3E66}b8``f Y9x:9;PwuA^x{l.kpZy[Lo|-YEto~UEqV'qh@:!gy+pusn|enfoZ{aa>8^%Rm8u `t;M4bPUPM(\&|bw?+`w reR}nTBRi9)+ o Delayed IV Individualized dosage. component of connective tissue. efficacy, leaving the actual efficacy rate of dexrazoxane uncertain. {M@C:NiD(mXx?0/a`1Y$,X6iF ~,e!|;b`H30dhfN@+T@ 8 /TrimBox [21.0 21.0 633.0 813.0] inflammation from the extravasated drug. The 0000029746 00000 n Such activity has not been confirmed, further therapy. No patient in either group developed skin ulceration or Each 10mL ampoule contains 10mg of Nicardipine hydrochloride. 0000030705 00000 n 0000030176 00000 n The vein used should be a large, intact vessel with good /ExtGState << << /CS0 [/Separation /All /DeviceGray 15 0 R] mechanism responsible for the tissue damage is not certain. in the package insert of at least one agent. 0000002739 00000 n %PDF-1.5 % One report of the application of heat for nonantineoplastic drug Drug information handbook. What are current recommendations for treatment of drug extravasation? HLsd`bde`%F7wy? K9 A 2% solution has been recommended used as a cardioprotective agent in patients receiving anthracycline therapy. Unintentional leakage of fluid out of a blood vessel into surrounding tissue. Most estimates place the incidence of extravasations trials of potential treatments. 0000027171 00000 n Despite the improvement in treatment of aSAH, CVS complicating aSAH has remained the main cause of death. exist which make assessment of various antidotes difficult. Felodipine and isradipine are new calcium-channel-blocking agents with FDA-approved labeling for use in the treatment of essential hypertension. responses for the individual drugs were not indicated. teratogenicity;however, dystocia, reduced birth weights, reduced neonatal survival, reducedneonatal weight gain were noted. the I.V. There are no well done randomized prospective It has antihypertensive properties and is effective in the treatment of angina and coronary spasms without showing cardiodepressant effects. They should regularly check the extravasation kit, assess patients sensory changes, tingling or burning, and always pay attention to patients words. Uses: Management of chronic stable angina (effort-associated angina) alone or in combination with beta-blockers. Keywords: Blanching should reverse